Quiz 62

Question 1

A 24-year-old African-American male presents with a history of several weeks of dyspnea, cough productive of bloody streaks, and malaise. His examination is normal except for bilateral facial nerve palsy. A CBC and urinalysis are normal. A chest radiograph reveals bilateral lymph node enlargement.This presentation is most consistent with: (check one)

Answer 1

Sarcoidosis,

disease of unknown etiology, affects young to middle-age adults (predominantly 20–29 years ld). In the U.S. it is more common in African-Americans. It is asymptomatic in 30%–50% of patients, and is often diagnosed on a routine chest film

one-third of cases will present with fever, malaise, weight loss, cough, and dyspnea. The pulmonary system is the main organ system affected, and findings may include bilateral hilar lymphadenopathy and discrete, noncaseating epithelial granulomas. Facial nerve palsy is seen in <5%

Hemoptysis does not generally occur until late in the course of sarcoidosis, and is usually related to Aspergillus infection or cavitation.

Question 2

Goodpasture’s syndrome

Answer 2

pulmonary hemorrhage, glomerulonephritis, and antiglomerular basement membrane antibodies. Hemoptysis, pulmonary alveolar infiltrates, dyspnea, and iron-deficiency anemia are frequent presenting features. Within days or weeks, the pulmonary findings are generally followed by hematuria, proteinuria, and the rapid loss of renal function.

Question 3

An elderly male patient takes aspirin, 81 mg daily, for prevention of a heart attack. He also takes herbal supplements.
Which one of the following supplements can have a negative interaction with aspirin?
  (check one)
 A. Kava 
 B. Yohimbine 
 C. Saw palmetto 
 D. Echinacea 
 E. Ginkgo biloba

Answer 3

Ginkgo biloba has been associated with serious intracerebral bleeding. In most of these patients, concurrent anticoagulant drugs were being used

Kava is associated with gastrointestinal side effects and skin rashes

Yohimbine is associated with hypertension

Question 4

Secondary causes of osteoporosis in males include which one of the following?

Answer 4

Corticosteroids are among the common secondary causes of osteoporosis in men. Other causes include excessive alcohol use, hypogonadism, vitamin D deficiency, and decreased body mass index.

Question 5

A 60-year-old male complains of multiple episodes of lightheadedness over the past 3 months, saying he felt as if he might “pass out” while sitting at his desk. His past medical history and a physical examination are unremarkable. An EKG shows right bundle branch block and left anterior hemiblock.
Which one of the following would be the most appropriate next step?

Answer 5

Cardiac event monitoring

This patient’s EKG demonstrates a right bundle branch block, as well as a left anterior hemiblock. This “trifascicular block” puts the patient at risk for tachyarrhythmias and bradyarrhythmias. Given the patient’s complaint of near-syncope, a heart monitoring study would be most appropriate.

Question 6

A health-care worker has a negative tuberculin skin test (Mantoux method). A second test 10 days later is positive. This result indicates:

Answer 6

A positive result on the second, but the not the first, step of a two-step Mantoux tuberculin skin test indicates long-standing, latent infection.

Question 7

You are examining a patient with a chronically painful shoulder. You forward flex the arm to 90° with the elbow bent to 90°. You then internally rotate the arm, which causes pain in the shoulder.
This finding suggests:

Answer 7

impingement/rotator cuff disorder

The maneuver described is Hawkins’ impingement test. Pain with this maneuver may signify subacromial impingement, including a rotator cuff tendinopathy or tear.

Question 8

A 26-year-old female presents with symptoms of anhedonia and anxiousness. Your evaluation leads to a diagnosis of major depressive disorder. The patient consents to medical treatment and counseling, but she is engaged to be married in 2 months and is concerned that antidepressants may lower her libido even further.
Which one of the following would be best for reducing the likelihood of sexual dysfunction?
(check one)
A. Bupropion (Wellbutrin)
B. Paroxetine (Paxil)
C. Fluoxetine (Prozac)
D. Sertraline (Zoloft)

Answer 8

Paroxetine has been found to cause higher rates of sexual dysfunction than bupropion, fluoxetine, and sertraline. Bupropion has been found to have significantly lower rates of adverse effects on sexual function than fluoxetine or sertraline.

Question 9

Should it become necessary, the patient’s decision-making capacity is determined by:
(check one)
A. The spouse or next of kin
B. The attending physician
C. A consulting psychiatrist
D. A judge, at the request of hospital social services or the physician

Answer 9

The attending physician